Fundus Image Capturing

ABSTRACT

An apparatus for producing a fundus image includes: a processor and a memory; an illumination component including a light source and operatively coupled to the processor; a camera including a lens and operatively coupled to the processor, wherein the memory stores instructions that, when executed by the processor, cause the apparatus to capture fundus images and provide controls for re-imaging the fundus.

RELATED APPLICATION(S)

This patent application is related to U.S. patent application Ser. No.14/633,601 filed on Feb. 27, 2015, U.S. patent application Ser. No.15/009,988 filed on Jan. 29, 2016, U.S. patent application Ser. No.14/177,594 filed on Feb. 11, 2014, and U.S. patent application Ser. No.15/054,558 filed on Feb. 26, 2016, the entireties of which are herebyincorporated by reference.

INTRODUCTION

People with type 1 or type 2 diabetes can develop eye disease as aresult of having diabetes. One of the most common diabetic eye diseasesis diabetic retinopathy, which is damage to the blood vessels of thelight-sensitive tissue at the back of the eye, known as the retina.Trained medical professionals use cameras during eye examinations fordiabetic retinopathy screening. The cameras can produce images of theback of the eye and trained medical professionals use those images todiagnose and treat diabetic retinopathy.

These images are produced either with pharmacological pupil dilation,known as mydriatic fundus imaging, or without pharmacological pupildilation, known as non-mydriatic fundus imaging. Because pupil dilationis inversely related, in part, to the amount of ambient light,non-mydriatic fundus imaging usually occurs in low lightingenvironments. Medical professionals can also use fundus imagingapparatus to detect or monitor other diseases, such as hypertension,glaucoma, and papilledema.

SUMMARY

In one aspect, a method for imaging a fundus of a patient includes:receiving an eye input, the eye input including an indication of a giveneye of the patient to image; receiving a focus input, the focus inputindicating an image point focus of a portion of the given eye; capturinga first image of the given eye at the image point focus; presenting acontrol on a graphical user interface, the control configured toinitiate an image acquisition sequence of the given eye; after receivingselection of the control, capturing a second image of the given eye atthe image point focus; and storing both the first image and the secondimage.

In another aspect, a method for capturing one or more images of a fundusof a patient includes: providing a summary interface on a display, wherethe summary interface includes: an indication of the number of imagescaptured for each eye, an indication of a focus type for each eye; andfor each captured image, an indication of the quality of the image. Themethod also includes: if only one image has been captured for a giveneye at an image point focus, provide a control to initiate an additionalimage capture; initiating a retinal image capture workflow, the retinalimage capture workflow resulting in image capture of the selected eyewith the selected focus type; and displaying to the summary interfaceafter capturing the second image.

In another aspect, a method for imaging a fundus of a patient includes:selecting a first prescriptive workflow for capturing a first image ofan eye, including: receiving a first eye input, the first eye inputindicating a given eye of the patient to image; receiving a first focusinput, the first focus input indicating a first image point focus of afirst portion of the given eye; and capturing a first image of the giveneye at the first image point focus. The method additionally includes:selecting a second prescriptive workflow for capturing a second image ofthe eye, including: receiving a second eye input, the second eye inputindicating the given eye of the patient to image; receiving a secondfocus input, the second focus input indicating a second image pointfocus of a second portion of the given eye; and capturing a second imageof the given eye at the second image point focus, and storing both thefirst image and the second image.

DESCRIPTION OF THE FIGURES

The following figures, which form a part of this application, areillustrative of described technology and are not meant to limit thescope of the claims in any manner, which scope shall be based on theclaims appended hereto.

FIG. 1 is an embodiment of an example system for recording and viewingan image of a patient's fundus;

FIG. 2 is an embodiment of an example fundus imaging system;

FIG. 3 is an embodiment of an example method for imaging a patient'sfundus using a fundus imaging system;

FIG. 4 is an embodiment of an example fundus imaging system;

FIG. 5 illustrates an example method of initiating a fundus imagingusing passive eye tracking;

FIG. 6 is an embodiment of an example use of a fundus imaging system;

FIG. 7 is an example computing device used within the fundus imagingsystem;

FIG. 8 is another embodiment of an example fundus imaging system;

FIG. 9 is another view of the fundus imaging system of FIG. 8;

FIG. 10 is another view of the fundus imaging system of FIG. 8;

FIG. 11 is another view of the fundus imaging system of FIG. 8;

FIG. 12 is another view of the fundus imaging system of FIG. 8;

FIG. 13 is another view of the fundus imaging system of FIG. 8;

FIG. 14 is another view of the fundus imaging system of FIG. 8;

FIG. 15 is another view of the fundus imaging system of FIG. 8;

FIG. 16 is another embodiment of an example fundus imaging system;

FIG. 17 is another view of the fundus imaging system of FIG. 16;

FIG. 18 is another view of the fundus imaging system of FIG. 16;

FIG. 19 is another view of the fundus imaging system of FIG. 16;

FIG. 20 is another view of the fundus imaging system of FIG. 16;

FIG. 21 is another view of the fundus imaging system of FIG. 16;

FIG. 22 is another view of the fundus imaging system of FIG. 16;

FIG. 23 is another view of the fundus imaging system of FIG. 16;

FIG. 24 is another view of the fundus imaging system of FIG. 16;

FIG. 25 is another view of the fundus imaging system of FIG. 16;

FIG. 26 is another view of the fundus imaging system of FIG. 16;

FIGS. 27A and 27B are other views of the fundus imaging system of FIG.16 in use with a patient;

FIG. 28 is an embodiment of an example eye cup for use with the fundusimaging system of FIG. 8;

FIG. 29 is another view of the eye cup of FIG. 28;

FIG. 30 is another view of the eye cup of FIG. 28;

FIG. 31 is another view of the eye cup of FIG. 28;

FIG. 32 is another view of the eye cup of FIG. 28;

FIG. 33 is another embodiment of an example system for recording andviewing an image of a patient's fundus;

FIG. 34 is an example method for sending messages to an apparatus forrecording and viewing an image of a patient's fundus in the system ofFIG. 33;

FIG. 35 is an example message from the method of FIG. 34;

FIG. 36 is an example workflow for automatically capturing fundus imagesusing the system of FIG. 33;

FIG. 37 is an example graphical user interface that allows for images tobe added to the system of FIG. 33;

FIG. 38 is an example graphical user interface that allows for themanual capture of images using the system of FIG. 33;

FIG. 39 is an example graphical user interface that allows forpre-selection of an eye position and fixation target using the system ofFIG. 33;

FIG. 40 is an example graphical user interface to assist in assist withaiming during capture of images using the system of FIG. 33;

FIG. 41 is an example graphical user interface including an indicationof a quality of an image captured using the system of FIG. 33;

FIG. 42 is another example graphical user interface including anindication of a quality of an image captured using the system of FIG.33; and

FIG. 43 is an example reporting table listing the images captured usingthe system of FIG. 33.

FIG. 44 is an example workflow for capturing fundus images using thesystem of FIG. 33.

FIG. 45 is an example workflow selection interface shown in the workflowof FIG. 44.

FIG. 46 is an example pre-acquisition interface shown in the workflow ofFIG. 44.

FIG. 47 is an example acquisition interface shown in the workflow ofFIG. 44.

FIG. 48 is an example post-acquisition interface shown in the workflowof FIG. 44.

FIG. 49 is an example exam summary interface shown in the workflow ofFIG. 44.

FIG. 50 is an example method of capturing fundus images using theworkflow of FIG. 44.

FIG. 51 shows additional operations of the method shown in FIG. 50.

FIG. 52 shows additional operations of the method shown in FIG. 50.

FIG. 53 shows example icons from the display portion of thepre-acquisition interface shown in FIG. 46.

FIG. 54 shows another embodiment of the example icons from the displayportion of the pre-acquisition interface shown in FIG. 46.

FIG. 55 shows another embodiment of the example icons from the displayportion of the pre-acquisition interface shown in FIG. 46.

FIG. 56 shows another embodiment of the example icons from the displayportion of the pre-acquisition interface shown in FIG. 46.

FIG. 57 shows another embodiment of the example icons from the displayportion of the pre-acquisition interface shown in FIG. 46.

FIG. 58 shows another embodiment of the example icons from the displayportion of the pre-acquisition interface shown in FIG. 46.

DETAILED DESCRIPTION

FIG. 1 is a schematic block diagram illustrating an example system 100for recording and viewing an image of a patient's fundus. In thisexample, the system 100 includes a patient P, a fundus imaging system102, a computing device 1800 including an image processor 106, a camera104 in communication with the computing device 1800, a display 108 incommunication with the computing device 1800 and used by clinician C,and a network 110. An embodiment of the example fundus imaging system102 is shown and described in more detail below with reference to FIG.4.

The fundus imaging system 102 functions to create a set of digitalimages of a patient's P eye fundus. As used herein, “fundus” refers tothe eye fundus and includes the retina, optic nerve, macula, vitreous,choroid and posterior pole.

In this example, one or more images of the eye are desired. Forinstance, the patient P is being screened for an eye disease, such asdiabetic retinopathy. The fundus imaging system 102 can also be used toprovide images of the eye for other purposes, such as to diagnose ormonitor the progression of a disease such as diabetic retinopathy.

The fundus imaging system 102 includes a handheld housing that supportsthe system's components. The housing supports one or two apertures forimaging one or two eyes at a time. In embodiments, the housing supportspositional guides for the patient P, such as an optional adjustable chinrest. The positional guide or guides help to align the patient's P eyeor eyes with the one or two apertures. In embodiments, the housingsupports means for raising and lowering the one or more apertures toalign them with the patient's P eye or eyes. Once the patient's P eyesare aligned, the clinician C then initiates the image captures by thefundus imaging system 102.

One technique for fundus imaging requires mydriasis, or the dilation ofthe patient's pupil, which can be painful and/or inconvenient to thepatient P. Example system 100 does not require a mydriatic drug to beadministered to the patient P before imaging, although the system 100can image the fundus if a mydriatic drug has been administered.

The system 100 can be used to assist the clinician C in screening for,monitoring, or diagnosing various eye diseases, such as hypertension,diabetic retinopathy, glaucoma and papilledema. It will be appreciatedthat the clinician C that operates the fundus imaging system 102 can bedifferent from the clinician C evaluating the resulting image.

In the example embodiment 100, the fundus imaging system 102 includes acamera 104 in communication with an image processor 106. In thisembodiment, the camera 104 is a digital camera including a lens, anaperture, and a sensor array. The camera 104 lens is a variable focuslens, such as a lens moved by a step motor, or a fluid lens, also knownas a liquid lens in the art. The camera 104 is configured to recordimages of the fundus one eye at a time. In other embodiments, the camera104 is configured to record an image of both eyes substantiallysimultaneously. In those embodiments, the fundus imaging system 102 caninclude two separate cameras, one for each eye.

In example system 100, the image processor 106 is operatively coupled tothe camera 104 and configured to communicate with the network 110 anddisplay 108.

The image processor 106 regulates the operation of the camera 104.Components of an example computing device, including an image processor,are shown in more detail in FIG. 7, which is described further below.

The display 108 is in communication with the image processor 106. In theexample embodiment, the housing supports the display 108. In otherembodiments, the display connects to the image processor, such as asmart phone, tablet computer, or external monitor. The display 108functions to reproduce the images produced by the fundus imaging system102 in a size and format readable by the clinician C. For example, thedisplay 108 can be a liquid crystal display (LCD) and active matrixorganic light emitting diode (AMOLED) display. The display can be touchsensitive.

The example fundus imaging system 102 is connected to a network 110. Thenetwork 110 may include any type of wireless network, a wired network,or any communication network known in the art. For example, wirelessconnections can include cellular network connections and connectionsmade using protocols such as 802.11a, b, and/or g. In other examples, awireless connection can be accomplished directly between the fundusimaging system 102 and an external display using one or more wired orwireless protocols, such as Bluetooth, Wi-Fi Direct, radio-frequencyidentification (RFID), or Zigbee. Other configurations are possible.

FIG. 2 illustrates components of an example fundus imaging system 102.The example fundus imaging system 102 includes a variable focus lens180, an illumination LED 182, an image sensor array 186, a fixation LED184, a computing device 1800, and a display 108. Each component is inelectrical communication with, at least, the computing device 1800.Other embodiments can include more or fewer components.

In one of the embodiments, the variable focus lens 180 is a liquid lens.A liquid lens is an optical lens whose focal length can be controlled bythe application of an external force, such as a voltage. The lensincludes a transparent fluid, such as water or water and oil, sealedwithin a cell and a transparent membrane. By applying a force to thefluid, the curvature of the fluid changes, thereby changing the focallength. This effect is known as electrowetting.

Generally, a liquid lens can focus between about −10 diopters to about+30 diopters. The focus of a liquid lens can be made quickly, even withlarge changes in focus. For instance, some liquid lenses can autofocusin tens of milliseconds or faster. Liquid lenses can focus from about 10cm to infinity and can have an effective focal length of about 16 mm orshorter.

In another embodiment of example fundus imaging system 102, the variablefocus lens 180 is one or more movable lenses that are controlled by astepping motor, a voice coil, an ultrasonic motor, or a piezoelectricactuator. Additionally, a stepping motor can also move the image sensorarray 186. In those embodiments, the variable focus lens 180 and/or theimage sensor array 186 are oriented normal to an optical axis of thefundus imaging system 102 and move along the optical axis. An examplestepping motor is shown and described below with reference to FIG. 4.

The example fundus imaging system 102 also includes an illuminationlight-emitting diode (LED) 182. The illumination LED 182 can be singlecolor or multi-color. For example, the illumination LED 182 can be athree-channel RGB LED, where each die is capable of independent andtandem operation.

Optionally, the illumination LED 182 is an assembly including one ormore visible light LEDs and a near-infrared LED. The optionalnear-infrared LED can be used in a preview mode, for example, for theclinician C to determine or estimate the patient's P eye focus withoutilluminating visible light that could cause the pupil to contract orirritate the patient P.

The illumination LED 182 is in electrical communication with thecomputing device 1800. Thus, the illumination of illumination LED 182 iscoordinated with the adjustment of the variable focus lens 180 and imagecapture. The illumination LED 182 can be overdriven to draw more thanthe maximum standard current draw rating. In other embodiments, theillumination LED 182 can also include a near-infrared LED. Thenear-infrared LED is illuminated during a preview mode.

The example fundus imaging system 102 also optionally includes afixation LED 184. The fixation LED 184 is in communication with thecomputing device 1800 and produces a light to guide the patient's P eyefor alignment. The fixation LED 184 can be a single color or multicolorLED. For example, the fixation LED 184 can produce a beam of green lightthat appears as a green dot when the patient P looks into the fundusimaging system 102. Other colors and designs, such as a cross, “x” andcircle are possible.

The example fundus imaging system 102 also includes an image sensorarray 186 that receives and processes light reflected by the patient'sfundus. The image sensor array 186 is, for example, a complementarymetal-oxide semiconductor (CMOS) sensor array, also known as an activepixel sensor (APS), or a charge coupled device (CCD) sensor.

The image sensor array 186 has a plurality of rows of pixels and aplurality of columns of pixels. In some embodiments, the image sensorarray has about 1280 by 1024 pixels, about 640 by 480 pixels, about 1500by 1152 pixels, about 2048 by 1536 pixels, or about 2560 by 1920 pixels.

In some embodiments, the pixel size in the image sensor array 186 isfrom about four micrometers by about four micrometers; from about twomicrometers by about two micrometers; from about six micrometers byabout six micrometers; or from about one micrometer by about onemicrometer.

The example image sensor array 186 includes photodiodes that have alight-receiving surface and have substantially uniform length and width.During exposure, the photodiodes convert the incident light to a charge.The image sensor array 186 can be operated as a global reset, that is,substantially all of the photodiodes are exposed simultaneously and forsubstantially identical lengths of time.

The example fundus imaging system 102 also includes a display 108,discussed in more detail above with reference to FIG. 1. Additionally,the example fundus imaging system 102 includes a computing device 1800,discussed in more detail below with reference to FIG. 7.

FIG. 3 is an embodiment of a method 200 for imaging a patient's fundususing a fundus imaging system. In the embodiment shown, the lighting isoptimally dimmed prior to execution, although lowering the lighting isoptional. The embodiment shown includes a set depth of field operation204, a set number of zones operation 206, an illuminate lightingoperation 208, an adjust lens focus operation 210, a capture imageoperation 212, repeat operation(s) 213, a show images operation 214 anda determine representative image operation 216. Other embodiments caninclude more or fewer steps.

The embodiment of method 200 begins with setting a depth of fieldoperation 204. In embodiments, the variable focus lens 180 is capable offocusing from about −20 diopters to about +20 diopters. Set depth offield operation 204 defines the lower and upper bounds in terms ofdiopters. For example, the depth of field range could be set to about−10 to +10 diopters; about −5 to about +5 diopters; about −10 to about+20 diopters; about −5 to about +20 diopters; about −20 to about +0diopters; or about −5 to about +5 diopters. Other settings are possible.The depth of field can be preprogrammed by the manufacturer.Alternatively, the end user, such as the clinician C, can set the depthof field.

As shown in FIG. 3, the next operation in embodiment of method 200 issetting the number of zones operation 206. However, zones operation 206can occur before or concurrent with field operation 204. In zonesoperation 206, the depth of field is divided into equal parts, whereeach part is called a zone. In other embodiments, the zones are not allequal. The number of zones is equal to the number of images captured incapture image operation 212.

For example, when the depth of field is from −10 to +10 diopters, thefocus of the variable focus lens can be changed by 4 diopters beforeeach image capture. Thus, in this example, images would be captured at−10, −6, −2, +2, +6 and +10 diopters. Or, images could be captured at−8, −4, 0, +4 and +8 diopters, thereby capturing an image in zones −10to −6 diopters, −6 to −2 diopters, −2 to +2 diopters, +2 to +6 dioptersand +6 to +10 diopters, respectively. In that instance, the depth offocus is about +/−2 diopters. Of course, the number of zones and thedepth of field can vary, resulting in different ranges of depth of fieldimage capture.

In embodiments, both depth of field and number of zones arepredetermined. For example, −10 D to +10 D and 5 zones. Both can bechanged by a user.

After the depth of field and number of zones are set, the next operationin embodiment of method 200 is the image capture process, which includesilluminate lighting operation 208, adjust lens focus operation 210 andcapture image operation 212. As shown in FIG. 3, the lighting componentis illuminated (lighting operation 208) before the lens focus isadjusted (lens focus operation 210). However, lens focus operation 210can occur before or concurrent with lighting operation 208.

The illumination LED 182 is illuminated in lighting operation 208. Theillumination LED 182 can remain illuminated throughout the duration ofeach image capture. Alternatively, the illumination LED 182 can beturned on and off for each image capture. In embodiments, theillumination LED 182 only turns on for the same period of time as theimage sensor array 186 exposure time period.

Optionally, lighting operation 208 can additionally include illuminatinga near-infrared LED. The clinician C can use the illumination of thenear-infrared LED as a way to preview the position of the patient's Ppupil.

The focus of variable focus lens 180 is adjusted in lens focus operation210. Autofocusing is not used in embodiment of method 200. That is, thediopter setting is provided to the lens without regard to the quality ofthe focus of the image. Indeed, traditional autofocusing fails in thelow-lighting non-mydriatic image capturing environment. The embodimentof method 200 results in a plurality of images at least one of which, ora combination of which, yields an in-focus view of the patient's Pfundus.

Additionally, the lack of autofocusing enables the fundus imaging system102 to rapidly capture multiple images in capture image operation 212 atdifferent diopter ranges. That is, variable focus lens 180 can be set toa particular diopter range and an image captured without the systemverifying that the particular focus level will produce an in-focusimage, as is found in autofocusing systems. Because the system does notattempt to autofocus, and the focus of the variable focus lens 180 canbe altered in roughly tens of milliseconds, images can be capturedthroughout the depth of field in well under a second, in embodiments.Thus, in the embodiment of method 200, the fundus imaging system 102 cancapture images of the entire depth of field before the patient's P eyecan react to the illuminated light. Without being bound to a particulartheory, depending on the patient P, the eye might react to the lightfrom illumination LED 182 in about 150 milliseconds.

The image sensor array 186 captures an image of the fundus in captureimage operation 212. As discussed above, the embodiment of method 200includes multiple image captures of the same fundus at different diopterfoci. The example fundus imaging system 102 uses a global reset orglobal shutter array, although other types of shutter arrays, such as arolling shutter, can be used. The entire image capture method 200 canalso be triggered by passive eye tracking and automatically capture, forexample, 5 frames of images. An embodiment of example method for passiveeye tracking is shown and described in more detail with reference toFIG. 5, below.

After the fundus imaging system 102 captures an image of the fundus, theembodiment of method 200 returns in loop 213 to either the illuminatelighting operation 208 or the adjust lens focus operation 210. That is,operations 208, 210 and 212 are repeated until an image is captured ineach of the preset zones from zones operation 206. It is noted that theimage capture does not need to be sequential through the depth of field.Additionally, each of the images does not need to be captured in asingle loop; a patient could have one or more fundus images captured andthen one or more after a pause or break.

After an image is captured in each of the zones (capture image operation212) in embodiment of method 200, either the images are displayed inshow images operation 214 or a representative image is determined inoperation 216 and then the image is displayed. Show images operation 214can include showing all images simultaneously or sequentially on display108. A user interface shown on display 108 can then enable the clinicianC or other reviewing medical professional to select or identify the bestor a representative image of the patient's P fundus.

In addition to, or in place of, show images operation 214, the computingdevice can determine a representative fundus image in operation 216.Operation 216 can also produce a single image by compiling aspects ofone or more of the images captured. This can be accomplished by, forexample, using a wavelet feature reconstruction method to select,interpolate, and/or synthesize the most representative frequency orlocation components.

The fundus imaging system 102 can also produce a three-dimensional imageof the fundus by compiling the multiple captured images. Because theimages are taken at different focus ranges of the fundus, thecompilation of the pictures can contain three-dimensional informationabout the fundus.

In turn, the image or images from operation 214 or 216 can be sent to apatient's electronic medical record or to a different medicalprofessional via network 110.

FIG. 4 illustrates an embodiment of example fundus imaging system 400.The embodiment 400 includes a housing 401 that supports an optionalfixation LED 402, an objective lens 404, fixation LED mirrors 405,variable focus lens assembly 406, display 408, printed circuit board410, step motor 412, image sensor array 414, and illumination LED 416.Also shown in FIG. 4 are light paths L that include potential lightpaths from optional fixation LED 402 and incoming light paths fromoutside the fundus imaging system 400. The illustrated components havethe same or similar functionality to the corresponding componentsdiscussed above with reference to FIGS. 1-3 above. Other embodiments caninclude more or fewer components.

The housing 401 of example fundus imaging system 400 is sized to be handheld. In embodiments, the housing 401 additionally supports one or moreuser input buttons near display 408, not shown in FIG. 4. The user inputbutton can initiate the image capture sequence, at least a portion ofwhich is shown and discussed with reference to FIG. 3, above. Thus, thefundus imaging system 400 is capable of being configured such that theclinician C does not need to adjust the lens focus.

Fixation LED 402 is an optional component of the fundus imaging system400. The fixation LED 402 is a single or multi-colored LED. Fixation LED402 can be more than one LED.

As shown in FIG. 4, pivoting mirrors 405 can be used to direct lightfrom the fixation LED 402 towards the patient's pupil. Additionally, anoverlay or filter can be used to project a particular shape or image,such as an “X”, to direct the patient's focus. The pivoting mirrors 405can control where the fixation image appears in the patient's view. Thepivoting mirrors 405 do not affect the light reflected from thepatient's fundus.

The embodiment of example fundus imaging system 400 also includes avariable focus lens assembly 406. As shown in FIG. 4, the variable focuslens assembly 406 is substantially aligned with the longitudinal axis ofthe housing 401. Additionally, the variable focus lens assembly 406 ispositioned between the objective lens 404 and the image sensor array 414such that it can control the focus of the incident light L onto theimage sensor array.

The example printed circuit board 410 is shown positioned within onedistal end of the housing 401 near the display 408. However, the printedcircuit board 410 can be positioned in a different location. The printedcircuit board 410 supports the components of the example computingdevice 1800. A power supply can also be positioned near printed circuitboard 410 and configured to power the components of the embodiment ofexample fundus imaging system 400.

Step motor 412 is an optional component in the example embodiment 400.Step motor 412 can also be, for example, a voice coil, an ultrasonicmotor, or a piezoelectric actuator. In the example embodiment 400, stepmotor 412 moves the variable focus lens assembly 406 and/or the sensorarray 414 to achieve variable focus. The step motor 412 moves thevariable focus lens assembly 406 or the sensor array 414 in a directionparallel to a longitudinal axis of the housing 401 (the optical axis).The movement of step motor 412 is actuated by computing device 1800.

The example image sensor array 414 is positioned normal to thelongitudinal axis of the housing 401. As discussed above, the imagesensor array 414 is in electrical communication with the computingdevice. Also, as discussed above, the image sensor array can be a CMOS(APS) or CCD sensor.

An illumination LED 416 is positioned near the variable focus lensassembly 406. However, the illumination LED 416 can be positioned inother locations, such as near or with the fixation LED 402.

FIG. 5 illustrates an alternate embodiment of initiate retinal imagingstep 306 using passive eye tracking. The initiate retinal imaging step306 operates to image the fundus of the patient P using passive eyetracking. In the initiate retinal imaging step 306, the fundus imagingsystem 102 monitors the pupil/fovea orientation of the patient P.Although the initiate retinal imaging step 306 is described with respectto fundus imaging system 102, the initiate retinal imaging step 306 maybe performed using a wearable or nonwearable fundus imaging system, suchas a handheld digital fundus imaging system.

Initially, at step 303, the pupil or fovea or both of the patient P aremonitored. The fundus imaging system 102 captures images in a firstimage capture mode. In the first image capture mode, the fundus imagingsystem 102 captures images at a higher frame rate. In some embodiments,in the first image capture mode, the fundus imaging system 102 capturesimages with infra-red illumination and at lower resolutions. In someembodiments, the infra-red illumination is created by the illuminationLED 182 operating to generate and direct light of a lower intensitytowards the subject. The first image capture mode may minimizediscomfort to the patient P, allow the patient P to relax, and allow fora larger pupil size without dilation (non-mydriatic).

Next, at step 305, the computing device 1800 processes at least aportion of the images captured by the fundus imaging system 102. Thecomputing device 1800 processes the images to identify the location ofthe pupil or fovea or both of the patient P. Using the location of thepupil or fovea or both in one of the images, a vector corresponding tothe pupil/fovea orientation is calculated. In some embodiments, thepupil/fovea orientation is approximated based on the distance betweenthe pupil and fovea in the image. In other embodiments, the pupil/foveaorientation is calculated by approximating the position of the fovearelative to the pupil in three dimensions using estimates of thedistance to the pupil and the distance between the pupil and the fovea.In other embodiments, the pupil/fovea orientation is approximated fromthe position of the pupil alone. In yet other embodiments, other methodsof approximating the pupil/fovea orientation are used.

Next, at step 307, the pupil/fovea orientation is compared to theoptical axis of the fundus imaging system 102. If the pupil/foveaorientation is substantially aligned with the optical axis of the fundusimaging system 102, the process proceeds to step 309 to capture a fundusimage. If not, the process returns to step 303 to continue to monitorthe pupil or fovea. In some embodiments, the pupil/fovea orientation issubstantially aligned with the optical axis when the angle between themis less than two to fifteen degrees.

Next, at step 309, fundus images are captured by triggering theembodiment of example thru focusing image capturing method 200. Inembodiments, five images are captured at step 309. In some embodiments,the fundus image is captured in a second image capture mode. In someembodiments, in the second image capture mode, the fundus imaging system102 captures images with visible illumination and at higher resolutions.In some embodiments, the visible illumination is created by theillumination LED 182 operating to generate and direct light of a higherintensity towards the subject. In other embodiments, the higherillumination is created by an external light source or ambient light.The second image capture mode may facilitate capturing a clear,well-illuminated, and detailed fundus image.

In some embodiments, after step 309, the initiate retinal imaging step306 returns to step 303 to continue to monitor the pupil/foveaorientation. The initiate retinal imaging step 306 may continue tocollect fundus images indefinitely or until a specified number of imageshave been collected. Further information regarding passive eye trackingcan be found in U.S. patent application Ser. No. 14/177,594 filed onFeb. 11, 2014, titled Ophthalmoscope Device, which is herebyincorporated by reference in its entirety

FIG. 6 is an embodiment of example use 500 of fundus imaging system 102.In the embodiment of example use 500, a clinician positions the fundusimaging system (operation 502), initiates image capture (operation 504),positions the fundus imaging system over the other eye (operation 506),initiates image capture (operation 508), and views images (operation520). Although the example use 500 is conducted without firstadministering mydriatic pharmaceuticals, the example use 500 can also beperformed for a patient who has taken a pupil-dilating compound. Theembodiment of example use 500 can also include lowering the lighting.The embodiment of example use 500 is conducted using the same or similarcomponents as those described above with reference to FIGS. 1-3. Otherembodiments can include more or fewer operations.

The embodiment of example use 500 begins by positioning the fundusimaging system (operation 502). In embodiments, the clinician firstinitiates an image capture sequence via a button on the housing or agraphical user interface shown by the display. The graphical userinterface can instruct the clinician to position the fundus imagingsystem over a particular eye of the patient. Alternatively, theclinician can use the graphical user interface to indicate which eyefundus is being imaged first.

In operation 502, the clinician positions the fundus imaging system nearthe patient's eye socket. The clinician positions the aperture of thesystem flush against the patient's eye socket such that the aperture, ora soft material eye cup extending from the aperture, seals out most ofthe ambient light. Of course, the example use 500 does not requirepositioning the aperture flush against the patient's eye socket.

When the fundus imaging system is in position, the system captures morethan one image of the fundus in operation 504. As discussed above, thesystem does not require the clinician to manually focus the lens.Additionally, the system does not attempt to autofocus on the fundus.Rather, the clinician simply initiates the image capture, via a buttonor the GUI, and the fundus imaging system controls when to capture theimages and the focus of the variable focus lens. Also, as discussedabove at least with reference to FIG. 5, the system can initiate imagecapture using passive eye tracking.

The patient may require the fundus imaging system to be moved away fromthe eye socket during image capture operation 504. The clinician canre-initiate the image capture sequence of the same eye using the buttonor the GUI on the display.

After capturing an image in each of the specified zones, the fundusimaging system notifies the clinician that the housing should bepositioned over the other eye (operation 506). The notification can beaudible, such as a beep, and/or the display can show a notification. Inembodiments, the system is configured to capture a set of images of onlyone eye, wherein the example method 500 proceeds to view imagesoperation 520 after image capture operation 504.

Similar to operation 502, the clinician then positions the fundusimaging system near or flush with the patient's other eye socket inoperation 506. Again, when the system is in place, an image is capturedin every zone in operation 508.

After images have been captured of the fundus in each pre-set zone, theclinician can view the resulting images in operation 520. As noted abovewith reference to FIG. 3, the images can be post-processed before theclinician views the images to select or synthesize a representativeimage. Additionally, the fundus images can be sent to a remote locationfor viewing by a different medical professional.

FIG. 7 is a block diagram illustrating physical components (i.e.,hardware) of a computing device 1800 with which embodiments of thedisclosure may be practiced. The computing device components describedbelow may be suitable to act as the computing devices described above,such as wireless computing device and/or medical device of FIG. 1. In abasic configuration, the computing device 1800 may include at least oneprocessing unit 1802 and a system memory 1804. Depending on theconfiguration and type of computing device, the system memory 1804 maycomprise, but is not limited to, volatile storage (e.g., random accessmemory), non-volatile storage (e.g., read-only memory), flash memory, orany combination of such memories. The system memory 1804 may include anoperating system 1805 and one or more program modules 1806 suitable forrunning software applications 1820. The operating system 1805, forexample, may be suitable for controlling the operation of the computingdevice 1800. Furthermore, embodiments of the disclosure may be practicedin conjunction with a graphics library, other operating systems, or anyother application program and is not limited to any particularapplication or system. This basic configuration is illustrated in FIG. 7by those components within a dashed line 1808. The computing device 1800may have additional features or functionality. For example, thecomputing device 1800 may also include additional data storage devices(removable and/or non-removable) such as, for example, magnetic disks,optical disks, or tape. Such additional storage is illustrated in FIG. 7by a removable storage device 1809 and a non-removable storage device1810.

As stated above, a number of program modules and data files may bestored in the system memory 1804. While executing on the at least oneprocessing unit 1802, the program modules 1806 may perform processesincluding, but not limited to, generate list of devices, broadcastuser-friendly name, broadcast transmitter power, determine proximity ofwireless computing device, connect with wireless computing device,transfer vital sign data to a patient's EMR, sort list of wirelesscomputing devices within range, and other processes described withreference to the figures as described herein. Other program modules thatmay be used in accordance with embodiments of the present disclosure,and in particular to generate screen content, may include electronicmail and contacts applications, word processing applications,spreadsheet applications, database applications, slide presentationapplications, drawing or computer-aided application programs, etc.

Furthermore, embodiments of the disclosure may be practiced in anelectrical circuit comprising discrete electronic elements, packaged orintegrated electronic chips containing logic gates, a circuit utilizinga microprocessor, or on a single chip containing electronic elements ormicroprocessors. For example, embodiments of the disclosure may bepracticed via a system-on-a-chip (SOC) where each or many of thecomponents illustrated in FIG. 7 may be integrated onto a singleintegrated circuit. Such an SOC device may include one or moreprocessing units, graphics units, communications units, systemvirtualization units and various application functionality all of whichare integrated (or “burned”) onto the chip substrate as a singleintegrated circuit. When operating via an SOC, the functionality,described herein, may be operated via application-specific logicintegrated with other components of the computing device 1800 on thesingle integrated circuit (chip). Embodiments of the disclosure may alsobe practiced using other technologies capable of performing logicaloperations such as, for example, AND, OR, and NOT, including but notlimited to mechanical, optical, fluidic, and quantum technologies. Inaddition, embodiments of the disclosure may be practiced within ageneral purpose computer or in any other circuits or systems.

The computing device 1800 may also have one or more input device(s) 1812such as a keyboard, a mouse, a pen, a sound or voice input device, atouch or swipe input device, etc. The output device(s) 1814 such as adisplay, speakers, a printer, etc. may also be included. Theaforementioned devices are examples and others may be used. Thecomputing device 1800 may include one or more communication connections1816 allowing communications with other computing devices. Examples ofsuitable communication connections 1816 include, but are not limited to,RF transmitter, receiver, and/or transceiver circuitry; universal serialbus (USB), parallel, and/or serial ports.

The term computer readable media as used herein may includenon-transitory computer storage media. Computer storage media mayinclude volatile and nonvolatile, removable and non-removable mediaimplemented in any method or technology for storage of information, suchas computer readable instructions, data structures, or program modules.The system memory 1804, the removable storage device 1809, and thenon-removable storage device 1810 are all computer storage mediaexamples (i.e., memory storage.) Computer storage media may include RAM,ROM, electrically erasable read-only memory (EEPROM), flash memory orother memory technology, CD-ROM, digital versatile disks (DVD) or otheroptical storage, magnetic cassettes, magnetic tape, magnetic diskstorage or other magnetic storage devices, or any other article ofmanufacture which can be used to store information and which can beaccessed by the computing device 1800. Any such computer storage mediamay be part of the computing device 1800. Computer storage media doesnot include a carrier wave or other propagated or modulated data signal.

Communication media may be embodied by computer readable instructions,data structures, program modules, or other data in a modulated datasignal, such as a carrier wave or other transport mechanism, andincludes any information delivery media. The term “modulated datasignal” may describe a signal that has one or more characteristics setor changed in such a manner as to encode information in the signal. Byway of example, and not limitation, communication media may includewired media such as a wired network or direct-wired connection, andwireless media such as acoustic, radio frequency (RF), infrared, andother wireless media.

Although the example medical devices described herein are devices usedto monitor patients, other types of medical devices can also be used.For example, the different components of the CONNEX™ system, such as theintermediary servers that communication with the monitoring devices, canalso require maintenance in the form of firmware and software updates.These intermediary servers can be managed by the systems and methodsdescribed herein to update the maintenance requirements of the servers.

Embodiments of the present invention may be utilized in variousdistributed computing environments where tasks are performed by remoteprocessing devices that are linked through a communications network in adistributed computing environment.

The block diagrams depicted herein are just examples. There may be manyvariations to these diagrams described therein without departing fromthe spirit of the disclosure. For instance, components may be added,deleted or modified.

While embodiments have been described, it will be understood that thoseskilled in the art, both now and in the future, may make variousimprovements and enhancements can be made.

As used herein, “about” refers to a degree of deviation based onexperimental error typical for the particular property identified. Thelatitude provided the term “about” will depend on the specific contextand particular property and can be readily discerned by those skilled inthe art. The term “about” is not intended to either expand or limit thedegree of equivalents which may otherwise be afforded a particularvalue. Further, unless otherwise stated, the term “about” shallexpressly include “exactly,” consistent with the discussions regardingranges and numerical data. Concentrations, amounts, and other numericaldata may be expressed or presented herein in a range format. It is to beunderstood that such a range format is used merely for convenience andbrevity and thus should be interpreted flexibly to include not only thenumerical values explicitly recited as the limits of the range, but alsoto include all the individual numerical values or sub-ranges encompassedwithin that range as if each numerical value and sub-range is explicitlyrecited. As an illustration, a numerical range of “about 4 percent toabout 7 percent” should be interpreted to include not only theexplicitly recited values of about 4 percent to about 7 percent, butalso include individual values and sub-ranges within the indicatedrange. Thus, included in this numerical range are individual values suchas 4.5, 5.25 and 6 and sub-ranges such as from 4-5, from 5-7, and from5.5-6.5; etc. This same principle applies to ranges reciting only onenumerical value. Furthermore, such an interpretation should applyregardless of the breadth of the range or the characteristics beingdescribed.

Referring now to FIGS. 8-15, another example fundus imaging system 600is shown. The embodiment 600 is similar to the fundus imaging system 400described above.

The fundus imaging system 600 includes a housing 601 that supports adisplay 602 at a first end and an opposite end 603 configured to engagean eye of the patient. As described herein, the fundus imaging system600 can be used to implement one or more of the described methods forimaging of the fundus.

Yet another embodiment of an example fundus imaging system 605 is shownin FIGS. 16-26. In this example, the body of the fundus imaging system605 can be formed of two or more materials overmolded upon one another.For example, a first polymeric material can be used to form the mainbody, and a second, softer polymeric material can be overmolded onto thefirst material to form bumper and/or grip areas, as depicted in FIG. 26.These overmolded areas provide a softer and slip-resistant surface foreasier grapping and holding of the fundus imaging system 605. Themultiple gripping surfaces allow the clinician C to decide how best tohold the fundus imaging system 605 in use.

Referring now to FIGS. 27A and 27B, the fundus imaging system 605 isshown in use on the patient. The fundus imaging system 605 is placedwith an end (e.g., opposite end 603) adjacent to or touching thepatient's face surrounding the desired eye socket.

Specifically, an end 607 of an example eye cup 606, shown in FIGS.28-32, is positioned at the end 603 of the fundus imaging system 600 or605. An opposite end 608 is positioned again the eye socket surroundingthe eye for which imaging will occur. In this example, the eye cup 606is formed of a polymeric material that is flexible in an accordion-likemanner. This allows the fundus imaging system 600 or 605 to be moved bythe clinician C towards and away from the patient's eye while stillmaintaining contact with the patient's face. Other configurations arepossible.

In another example system 700 for recording and viewing an image of apatient's fundus shown in FIG. 33, the system 700 is cloud-based (e.g.,includes a plurality of servers with storage accessible from a largenetwork such as the Internet) and allows for communication and storageof fundus images across LANs, WANs, and the Internet. In this example, adevice 702, which is identical and/or similar to the systems 600, 605described above, can be used to capture an image, associate that imagewith a patient, review the image, and annotate the image as desired.

Upon completion, the image can be uploaded to a cloud system 704 using abatch or more instant configuration. When uploaded, the image can betagged with device and patient information, such as a barcode associatedwith the patient and/or a patient picture. The cloud system 704 can beconfigured to provide patient lists and to accept or reject an imagebased upon given criteria, such a patient name and quality of image. Thecloud system 704 can also be used to provide notifications, such asimage availability, to the clinician C and/or patient. In addition, thecloud can forward the image and patient information to an EMR 706 forstorage.

In addition, the cloud system 704 can be used to provide a portal toallow for access to images by a device 708 of the clinician C and/orpatient device 710 using a computing device such as a personal computingdevice, tablet, and/or mobile device. This can allow the images to beviewed, manipulated, etc. The cloud system 704 can be used to captureclinician C annotations and diagnoses. In addition, the cloud system 704can be configured to interface with other third parties, such asinsurance companies to allow for billing.

In some examples the systems 600, 605 can be configured to operate inboth manual and automatic modes when interfacing with the cloud system704. In one example, the automatic mode includes one or more scriptsthat automate certain processes for the systems 600, 605. See FIG. 36described below. These processes can include automation of image focusand capture (acquisition) and output to the cloud for storage. In themanual mode, the various processes can be manually controlled by theclinician C, such as focus on the fundus, capture of one or more imagesat desired times, and then uploading of the image(s) to the cloud. SeeFIG. 37 described below.

A notification scheme is used for charging of the systems 600, 605. Inthese examples, the systems 600, 605 are wireless and include arechargeable battery pack, such as a lithium-ion battery or similarbattery. In this example, a bi-color LED is used to indicate a status ofcharging of the battery pack when placed in a charging cradle 703. TheLED is left off if charging is not occurring—this is the default state.When the systems 600, 605 are charging (e.g., when plugged into a dock),the LED is illuminated a solid amber to indicate charging of the batteryand a solid green when the battery charging is completed. If an erroroccurs during charging, the LED flashes an amber color. Otherconfigurations are possible.

Different example operating states for the fundus imaging systems 600,605 are possible. For a clinician that gathers the images from thepatient, the systems 600, 605 can be used to select a patient, adjustthe eye cap, take an image, determine a quality of the image, and reviewthe status of an image capture process. In addition, various otherfeatures, such as adjustment of connectivity (e.g., WiFi) and cleaningof the device can be accomplished. Additional details on some of theseprocesses are provided below.

Further, a physician (sometimes the same individual who captured theimages or a different individual, such as an individual located at aremote location) can review the results of the image captures anddevelop/review a report based upon the same. See FIG. 45 describedbelow.

Example processes are performed in the cloud system 704 based upon eachindividual or service within the system. For the clinician capturing theimages, the cloud system 704 can be used to add new patients, schedulethe procedure, and check the status of the procedure. For the physicianreviewing the images, the cloud system 704 can be used to check status,review the images, and generate/review a report based upon review of theimages. Notifications can also be created and sent to, for example, theclinician or patient.

The systems 600, 605 can be used to transmit scheduling and/or imageinformation to and from the cloud system 704. The EMR 706 is incommunication with the cloud system 704 to transmit and store image anddiagnoses information for each patient. Other configurations arepossible.

An over read service 712 is also shown in FIG. 33. The over read service712 can interact with the cloud system 704 to provide additionalresources for analyzing the images, including reading of images andgenerating of reports. Other functions of the example system 700 includecapture and forwarding of images to the cloud and communication betweenthe cloud and the EMR 706 for storage thereof.

For example, in one embodiment, the device 702 is used to capture one ormore fundus images. After capture, the device 702 is returned to thecharging cradle 703. Upon placement of the device 702 into the cradle703, the captured images are automatically transferred to the cloudsystem 704. This transfer can be automated, so that no further action isrequired by the user to transfer the images from the device 702 to thecloud system 704.

Upon submission to the cloud system 704, the images can be automaticallyreviewed for quality. The images can also be automatically forwarded tothe over read service 712 for review. One or more clinicians canthereupon review the images and provide feedback from the over readservice 712 back to the cloud system 704. At this point, the cloudsystem 704 can provide notification to the devices 708, 710 regardingthe information from the over read service 712.

An example method for using the systems 600, 605 to capture fundusimages includes preliminary tasks such as the capturing of patientvitals and education of the patient on the procedure are done. Once thisis done, the system 600, 605 is powered on and the patient is selectedon the device. The eye cup is then positioned on the patient and one ormore images are captured using automated and/or manual processes. Theimages can then be checked. If accepted, the images are saved and/oruploaded to the cloud. The system 600, 605 can be powered off andreturned to its cradle for charging. A physician can thereupon reviewthe images, and the clinician C or patient can be notified of theresults.

In an example method for obtaining a good quality image of the fundususing the systems 600, 605, after an image is captured, the cliniciancan accept or reject the image. If rejected, a script can be executedthat provides manual or automated instructions on how to capture adesired image quality. The clinician thereupon gets another opportunityto capture an image and then to accept or reject it. If the image isaccepted, automated processes can be used to determine a quality of theimage. If accepted, further scripting can occur. If not, the cliniciancan be prompted to take another image.

An example method is provided to allow for capture of images even whenthe system 600, 605 loses connectivity with the cloud. In such aninstance, automated quality checks may not be provided, and theclinician may be prompted as such. The clinician can then decide whetheror not to accept the image without the quality check or to cancel theprocedure. In addition, the system 600, 605 can be used to trouble shootconnectivity issues, as described further below.

An example method for allowing the clinician to select the patient onthe system 600, 605 includes a work list that is provided thatidentifies patients based upon one or more given criteria, such as theclinician, location, time of day, etc. The clinician is thereupon ableto select the patient and confirms the proper patient has been selected,such as by comparing a code with one worn by the patient for from apicture of the patient. Thereupon, after selection of the patient, oneor more images can be captured and stored. The captured images areassociated with the selected patient.

In a similar manner, an example method allows the clinician to assurethat the proper patient is selected. Upon power-up of the system 600,605, unique information is sent to the cloud, such as the system'sserial number. The could looks-up the serial number and returns a listof patients associated with that system. The clinician can thereuponselect the patient from the list or manually enter the patient into thesystem 600, 605 if the patient is not on the work list.

A user interface allows the user to pick between a selection ofpatients, examinations, review, and settings. If a patient is selected,the system 600, 605 proceeds with imaging of the fundus using anautomated and/or manual process. Icons are used to represent differentcontexts on the user interfaces of the system 600, 605.

The following example workflows/methods are implemented by the systems600, 605. Additional details regarding these workflows can also be foundwith reference to FIGS. 36-44.

An example method for automatic examination and image capture startswhen the clinician selects the examination icon on the system 600, 605.Upon initiation, the clinician is presented with an interface thatallows for automatic acquisition of the fundus image. This can beaccomplished in three stages, including pre acquisition, acquisition,and post-acquisition. During pre-acquisition, the clinician selects thepatient and configures the system as desired. During acquisition, theimage is captured using automated or manual processes. Finally,post-acquisition, quality checks are performed and the clinician cansave the image(s) if desired. See FIG. 36 described further below.

An example method for adjusting certain settings of the system 600, 605includes, for example, brightness and focus, which can be selectedautomatically or manually manipulated by the clinician.

An example method for manually acquiring an image is similar to themethod described above, except the acquisition of the images is donemanually by the clinician. This is accomplished by the clinicianmanually indicating when an image is to be taken. Upon capture, theimage can be verified manually or automatically.

An example method for navigating one or more captured images includes auser interface that is used to scroll through the captured images in asequence. Upon review, the images can be submitted, if desired.

An example method for selecting a patient from a worklist starts uponselection of the patient icon from the interface for the system 600,605. A list of patients is presented to the clinician in the worklist.The clinician can select a patient from the list to be presented withadditional information about that patient, such as full name, date ofbirth, and patient ID. If any unsaved images exist, those images areassociated with the selected patient. If not, a new examination routineis executed to allow for capture of images to be associated with theselected patient.

An example method allows for the clinician to manually enter new patientinformation into the system 600, 605. This includes patient name, dateof birth, and/or patient ID. Once entered, the patient information canbe associated with captured images.

An example method allows the clinician to search for a specific patientusing such parameters as patient name, date of birth, and/or patient ID.Once found, the clinician selects the patient for further processing.

An example method for refreshing the patient worklist includes assumingthere is connectivity (e.g., to the cloud), the clinician selecting arefresh button to manually refresh the list with the most currentpatient names. The system 600, 605 is also programmed to periodicallyrefresh the list automatically at given intervals and at other givenperiods, such as upon startup or shutdown. Other configurations arepossible.

An example method allows a clinician to review a patient test on thesystem 600, 605. Upon selection of a patient, the clinician can reviewpatient summary information (e.g., full name, date of birth, and patientID) and previous examination summary information, such as items from theexamination and image quality scores, which indicate how good the imagequality was from those examinations.

An example method for saving images allows, after acquisition, theclinician to review the images in sequence. For each image in theworkspace, the image is quality-checked and the status of the image isdisplayed to the clinician. The clinician uses the user interface toreview each acquired image and to save or discard the image.

An example method labeling eye position allows the clinician to selectupon five eye positions, including off (default), left eye optic disccentered, left eye macula centered, right eye macula centered, and righteye optic disc centered.

An example method allows for manual adjustment of settings for imageacquisition. In this example, the clinician has access to varioussettings that can be adjusted manually, such as PET and focus andbrightness. See FIG. 38 described below.

An example method for adding images includes, once an image is captured,the clinician manually adding the image to a workspace if desired. Onceadded, the image can be reviewed and stored, if desired. In thisexample, up to four images can be added to a workspace for review. Otherconfigurations are possible. See FIG. 37 described below.

An example method for entering advanced settings such settings asvolume, time, date, etc. can be accessed upon entering of a password oraccess code by the clinician. In one method, an access code is needed tochange certain settings, and an advanced settings code is needed tochange other advance settings. Other configurations are possible.

In an example method for selecting network connectivity, a plurality ofWiFi networks are shown, and the clinician can select one for connectionthereto. Upon successful connection, the system 600, 605 can communicatewith the cloud.

In an example method for image inspection, once an image is selected, itis displayed to the clinician for review. The user can discard the imageor move forward with image capture, as desired.

In an example method for discard of an image, a number of discards istallied. If over a threshold amount (e.g., 2, 3, 5, 10, etc.), a warningcan be given that further image acquisition could be uncomfortable forthe patient.

In an example method for returning to a home screen, a home button isprovided on each interface. When selected, the home screen interface isshown, allowing the clinician to make initial selections like patientlist, examination, review, and settings.

If the home button is selected when there are unsaved images, theclinician is first prompted to save or discard the images beforereturning to the home screen. In this example, the method includesdisplaying a prompt with a save button to allow the clinician to savethe images. Once saved, the home screen is displayed.

In an example method for docking the system 600, 605, the system 600,605 is placed in a charging cradle. Upon connection with the cradle, anicon indicating a USB connection is displayed on the dock and/or thesystem 600, 605. If acquisition is complete, the screen is turned offand sleep is instituted without a certain time period (e.g., oneminute). If acquisition is not complete, the clinician is prompted tocomplete acquisition.

In an example method for assuring that all items for an examination havebeen received or overridden, if items are missing, the save button isdisabled. However, the clinician can select the override button and, incertain contexts, allow for saving of data without all required items(e.g., a skipped indication) being present.

In an example method for updating software on the system 600, 605,software can be uploaded from a removable storage medium (e.g., SD card)during boot to update the software on the system 600, 605. In otherexamples, software can be downloaded, such as from the cloud.

In another example for waking the system 600, 605 from sleep, the usercan press the home button to wake the system. Upon wake, a login screencan be presented, requiring the clinician to enter an access code to usethe system 600, 605.

In some examples a method is provided for training purposes. In thisembodiment, training information can be accessed from the home screen.The training can provide user interface information that trains the useron the configuration and use of the system 600, 605.

Referring now to FIGS. 34-35, in some example, the system 700 allows formessaging to the clinician who is capturing the fundus images. Forexample, the cloud system 704 and/or the clinicians working as part ofthe over read service 712 can directly message the clinician capturingthe fundus images regarding such as issues as image quality.

For example, FIG. 34 shows a method 720 that allows the over readservice to message the clinician obtaining the fundus images with thedevice 702. Such messages can be addressed using various methods, suchas device name, device ID (serial number/MAC address), device IPaddress, etc. In this example, one or more messages are provided by theover read service 712 to the cloud system 704. At operation 722, thedevice 702 connects to the cloud system 704 using a known protocol, suchas TCP/IP. At operation 724, a determination is made regarding whetheror not a message is waiting for the device 702. If so, control is passedto operation 726, and a determination is made regarding whether or not aparticular graphical user interface (e.g., a home screen) is beingdisplayed on the device 702. If so, control is passed to operation 728,and a message is presented to the clinician on the graphical userinterface.

At FIG. 35, one example of such a message 729 is shown. The message 729can be displayed so as to get the attention of the clinician operatingthe device 702, such as by popping up, color, sound, etc. The message729 can provide information regarding the quality of the images thathave been captured by the device 702. For example, if the images are notof a sufficient quality for the over read service 712, the over readservice 712 can send a message to the device 702. The clinician C canread the message, as well as information about how to remedy thesituation (e.g., the message could provide information such as “Clean acertain part of the lens, etc.).

In addition to the messaging between the device 702 and the cloud system704 described above, the cloud system 704 can be used to store variousinformation associated with the examination of a given patient. Forexample, as the fundus images are captured, the clinician C can adjustvarious settings associated with the device 702, such as brightness,focus, etc. Once a desired set of settings is identified for aparticular patient, these settings can be stored in the cloud system 704(e.g., in a database) and/or the EMR 706 and associated with thepatient. When the patient returns for a subsequent examination, thedevice 702 can be configured to automatically access the settings forthe device 702 by downloading the settings from the cloud system 704. Inthis manner, the device 702 can be automatically configured according tothose settings for subsequent capture of the patient's fundus images.

Referring now to FIG. 36, an example workflow 730 for automaticallycapturing fundus images using the device 702 is shown. The workflow 730is automatically performed by the device 702 to provide a standardizedfundus examination. The workflow 730 includes a selection stage 732, apre-acquisition stage 734, an acquisition stage 736, and apost-acquisition stage 738.

At the selection stage 732, the clinician C is presented with a menu ofoptions, including an examination icon. The clinician C selects theexamination icon to initiate the workflow 730.

At the pre-acquisition stage 734, the clinician C is presented by thedevice 702 with options to start the workflow 730 or to perform a manualcapture of fundus images (see FIG. 37). The clinician C selects the“Start” button 735 to begin the workflow 730 (or can select the manualcapture icon 737 to manually capture images as described further below.

At the acquisition stage 736, the device 702 automatically captures thedesired fundus images from the patient P. The image capture can includeone or more tones indicating the capture of images, along with automatedquality checks on the images. An example of such a process forautomating the capture of fundus images is described in U.S. patentapplication Ser. No. 15/009,988.

Finally, at the post-acquisition stage 738, the clinician C can reviewthe captured images. The clinician C can perform such actions asdiscarding images and/or adding images, as described further below.

For example, the clinician C can decide to discard one or more of thefundus images. In one example, the clinician C is provided with variousoptions. If one option is selected (e.g., a “Close” icon 742), thedevice 702 returns to the pre-acquisition stage 734. If another optionis selected (e.g., a trash icon 744), the device 702 returns to theacquisition stage 736 to allow for the immediate retake of the fundusimage(s). Other configurations are possible.

In another example, clinician C can add images for the patient P. Inthis example shown in FIG. 37, a user interface includes a control 748that allows the clinician C to add images by returning the device 702 tothe pre-acquisition stage 734. At that point, the device 702 can be usedto capture further fundus images that are associated with the patient P.

In addition, other workflows can be performed by the device 702. Forexample, the workflow 730 can be a default workflow for the device 702,but the device 702 can be configured to perform a modified workflowdepending on which over read service 712 is used. For example, aparticular over read service 712 may be defined requirements for suchparameters as: number of fundus images; type of fundus images (e.g.,left, right, macula centered, optic disc centered, etc.); order ofcapture sequence.

In some examples, the workflow for the device 702 is defined by one ormore scripts. The scripts can be downloaded from the cloud system 704 toallow for the modification of the functionality of the device 702. Aparticular script can be selected by the clinician C to modify theworkflow for the device 702. In addition, the device 702 can beprogrammed to automatically select a script based upon such parametersas clinician C preference, over read service, etc.

In addition to the automated workflow 730, other configurations arepossible. For example, as part of the automated capture of fundusimages, the clinician C can select to manually capture one or morefundus images. Specifically, during the pre-acquisition stage 734 or theacquisition stage 736, the clinician C can select one of the manualcapture icons 737, 758 to have the device 702 capture an image. Otherconfigurations are possible.

Referring now to FIG. 39, in some examples, the pre-acquisition stage734 allows the user to pre-select an eye position and fixation targetbefore taking fundus image(s). In this example, controls 762 areprovided that allow the clinician C to select eye position (e.g., left,right, macula centered, optic disc centered, etc.) before images areeither automatically (by selecting “start”) and/or manually (byselecting “manual”) captured using the device 702.

When manually capturing images, the device 702 is programmed as depictedin FIG. 40 to assist the clinician C with aiming the device 702 forcapturing the fundus image(s). In this example, a circular element 770guides the clinician C with the initial approach of the device 702 tothe eye. A diamond element 772 thereupon provides the user withadjustment guidance once the device 702 is in the correct proximity tothe patient P's eye. Specifically, when the device 702 is focused in theinner eye, a retina reflection will appear in the view. The clinician Ccan thereupon use micro adjustments of the barrel of the camera to movethe reflection into the diamond element 772. Once in position, thedevice 702 will automatically trigger a capture of the image.

Referring now to FIGS. 41-42, the device 702 provides the clinician Cwith a readily discernable indication of image quality after the imageis captured. As shown in FIG. 41, the device 702 provides an indicator802 that indicates the quality of the captured fundus image. In thisexample, color (e.g., red is bad, yellow is passable, green is good) isused, along with a signification of quality (e.g., check mark ispassable). In addition, the indicator 802 includes a quality score, suchas a value ranging from 0 (lowest quality) to 100 (highest quality). Inanother example of FIG. 42, the red “X” indicates a poor quality imagethat fails the lowest standards for, for example, the over read service.In such a scenario, the fundus images can be recaptured using the device702. Other configurations are possible.

Once fundus images have been captures, the device 702 provides areporting table 850 shown in FIG. 43. This reporting table 850 providesa summary of the images for easy review by the clinician C. In thisexample, the reporting table 850 includes an entry 852 for each image.This entry 852 provides an indication of the image quality (e.g., usingthe color, icon, and/or scores described above) and image type (e.g.portion of the image captured). The clinician C can edit contextualinformation associated with the images, such as the image type. Theclinician C can also select one or more of the entries 852 to performsuch functions as discard and/or retake certain images. After review iscomplete, the clinician C can select a save button 854 to save thedesired images and/or upload those images to the cloud system 704. Otherconfigurations are possible.

FIGS. 44-52 provide additional embodiments of example systems forrecording and viewing an image of a patient's fundus. In these examples,the systems provide for the capture of multiple images of an eye and/ormultiple workflows to capture images of an eye.

Referring now to FIG. 44, an example workflow 1000 for automaticallycapturing fundus images using device 702 is shown. The workflow 1000 isperformed by device 702 to provide a standardized fundus examination.Workflow 1000 includes a workflow selection interface 1001, apre-acquisition interface 1020, an acquisition interface 1050, apost-acquisition interface 1070, and an exam summary interface 1100.Other embodiments can include more or fewer interfaces (stages).

At workflow selection stage 1000, the clinician C is provided withvarious navigational controls. More specifics about workflow selectioninterface 1001 are described below with reference to FIG. 45. Ifclinician C selects exam control 1002, device 702 proceeds to initiate awork flow for acquiring fundus images of a patient.

After selecting exam control 1002, device 702 provides pre-acquisitioninterface 1020 on the display. Generally, pre-acquisition interface 1020enables the clinician C to indicate: which eye will be imaged, a focusinput for the given eye, and whether to proceed automatically or in amanual mode. Other navigational controls, and additional functionality,provided on pre-acquisition interface 1020 are described below in moredetail with reference to FIG. 46. When clinician C selects either thestart or manual control, device 702 proceeds to the acquisition stage1050.

At the acquisition stage 1050, device 702 captures a fundus image. Asmentioned above, the image capturing may be performed automatically, orif clinician C selected manual control in pre-acquisition stage 1020,clinician C uses controls on acquisition interface 1050 to initiateimage capture. Additional details about acquisition interface 1050 areprovided with reference to FIG. 47 below.

After device 702 acquires a fundus image, the display of device 702shows post-acquisition interface 1070. At post-acquisition stage 1070,the clinician C can review the captured image. Additionally, interface1070 provides an indication of the image quality, the opportunity todelete the captured image, and/or controls to initiate additional imageacquisition sequences of the given eye. If the additional image sequencecontrol is selected, device 702 proceeds to capture a second image ofthe given eye at the previously selected image point focus. In thoseinstances, workflow returns to acquisition stage 1050. Additionaldetails regarding post-acquisition interface 1070 are provided withreference to FIG. 48 below.

After displaying post-acquisition stage 1070, device 702 then displaysexam summary interface 1100. Exam summary interface 1100 generallydepicts information summarizing which eyes have images captured thereforand at what image point focus. Advantageously, exam summary interface1100 also provides controls for additional image capture sequenceinitiation for a particular eye at a particular image point focus.Additional details regarding exam summary interface 1100 are describedbelow with reference to FIG. 49.

Referring to FIG. 45, work flow selection interface 1001 includesvarious controls enabling clinician C to navigate about various workflows provided by device 702. As shown, workflow selection interface1001 includes a patient control 1004, an exam control 1002, a reviewcontrol 1006, settings control 1008, and training control 1010. Otherembodiments can include more or fewer controls.

Exam control 1002 initiates image capture workflow 1000 described abovewith reference to FIG. 44, and discussed below with reference to FIGS.50-52. Patients control 1004 enables clinician C to add or edit patientdata. Review control 1006 enables clinician C to review previouslycaptured images during a particular session for a particular patient, orfor the particular clinician C. Settings control 1008 provides clinicianC the ability to modify various device settings 702, such as framecapture rate, display brightness, Wi-Fi network connectivity, and thelike. Training control 1010 enables clinician C to review one or moretraining documents such as videos and/or instructional pamphlets.

Referring now to FIG. 46, pre-acquisition interface 1020 providescontrols for clinician C to select which eye to be imaged and at whatimage point focus. Image point focus is a portion of the fundus thatdevice 702 will focus on during image capture. In the embodiment shown,there are two image point foci that are associated with differentprescriptive workflows: optic-disc centered and macula-centered. Theseare described further below with reference to FIGS. 53-58.

Icons 1039 and 1042 provide an indication of the image point focus.Control 1039 initiates image capture sequence of a patient's left eyethat is macula-centered. Control 1042 initiates image capture that hasan optic disc-centered focus for the left eye. Display portion 1022includes a darkened indicator dot 1024 that device 702 will image theleft eye in optic disc-centered focus. The eye that will not be imagedis shown grayed out, as in icon 1030.

In display portion 1022, the left eye 1026 is shown and a dot 1024 isshown indicating the focus point for the image. In various embodiments,dot 1024 can be red, green, or other colors. Display portion 1022 alsoincludes an indication 1028 of which eye and which prescriptive workflowwill be used for capture. In the interface shown, FIG. 46, this will bethe first image at the particular image point focus for the left eye, asindicated L1 in portion 1028. See FIGS. 53-58 for additional details onthe positioning of the dot 1024 according to indicate the focal pointfor optional multiple prescriptive workflows.

The acquisition interface 1020 also includes start control 1032 andmanual start control 1034. Start control 1032 initiates an automaticimaging sequence where device 702 does not require clinician C toinitiate the actual image capture. In contrast, manual control 1034initiates an imaging acquisition sequence that requires clinician C toinitiate image capture.

Pre-acquisition interface 1020 also includes summary section 1038.Summary section 1038 provides clinician C with a summary of which eyeshave been imaged and at what image point focus. Adjacent to summary 1038are navigational buttons 1036 and 1037. Control 1036 causes device 702to bring up exam summary interface 1100. Control 1037 causes device 702to return to a home page. In some instances, the home page can be workflow selection interface 1001.

Referring now to FIG. 47, the acquisition interface 1050 is shown.Acquisition interface 1050 includes image capture controls 1052. In theembodiment shown, both the upper left and upper right corners ofinterface 1050 include controls 1052. In most instances, controls 1052are not provided in an automatic image capture mode.

Acquisition interface 1050 also includes preview portion 1054. Previewportion 1054 enables clinician C to preview what the image sensor arraymight capture during an image capture. Because there is typically sometime delay between selection of control 1052 and actual image capture bythe image sensor array, what appears on the previous screen may or maynot be the image captured by device 702.

Acquisition interface 1050 also includes indicators 1056 and 1057, whichshow the image point focus and eye and image capture number for thegiven eye, respectively. Acquisition interface 1050 also includescontrol 1058. Control 1058 causes the workflow to return topre-acquisition interface 1020.

Referring now to FIG. 48, post-acquisition interface 1070 is provided.Post-acquisition interface 1070 includes image preview 1071, which is areproduction of the image captured during manual or automatic imaging asprovided by device 702 in acquisition sequence 1050. Post-acquisitioninterface 1070 also includes indicator icons 1072 and 1074, whichindicate the eye imaged, the image point focus and number images thathave been captured for that particular eye.

Post-acquisition interface 1070 includes additional image capturecontrol 1076. Generally, the example additional image capture control1076 is a visual indicator that juxtapositions an iris, or shutter, iconand a “+”, or add, icon. The additional image capture control 1076 is acontrol for adding an image.

Specifically, the additional image capture control 1076 causes device702 to capture another image of a given eye at the image point focus,without requiring any further input from the user (e.g., to select orprovide any imaging settings). Selection of additional image capturecontrol 1076 causes device 702 to display acquisition interface 1050 sothat an additional image of the eye at the selected focal point can betaken.

After device 702 acquires the fundus image, device 702 analyzes theimage for its quality and provides an image quality score onpost-acquisition interface 1070. This is indicator 1078. Methods fordetermining image quality, and other specifics relating thereto, arediscussed in more detail above.

Post-acquisition interface 1070 can include various other controls. Forexample, control 1082 initiates an image inspection workflow, whereclinician C can zoom in on various portions of the captured image,navigate about the image, and/or view various parameters relating to thecaptured image. Control 1080 causes the workflow to proceed to displayexam summary interface 1100. Control 1084 discards the captured imageand causes the workflow to return to acquisition interface 1050. Control1086 discards the captured image and causes the workflow to return topre-acquisition interface 1020.

Referring now to FIG. 49, exam summary interface 1100 is shown. Examsummary interface 1100 includes patient context pane 1102, whichincludes icon 1103. Patient context pane 1102 indicates whether there isany patient context for the particular patient whose fundus has justbeen imaged. Patient context can include patient ID, patient name, andthe like. Icon 1103 indicates whether patient context has been acquired.In the embodiment shown, icon 1103 indicates that no patient context hasyet been provided and/or acquired.

Exam summary interface 1100 also includes right eye summary pane 1104and left eye summary pane 1106. Summary panes 1104 and 1106 provideindicators about how many images have been captured for each eye, atwhat image focus points, and additionally provide controls forinitiating additional images to be captured of a particular eye at agiven image point focus. Summary regions 1104 and 1106 also includeimage quality scores 1130. Icons 1112 indicate that no images havingbeen captured that meet the particular number (first or second image),eye, and image point focus. Accordingly, if no image has been captured,there is no image quality, as indicated by question marks 1132.

Icon 1108 provides information about captured images. Icon 1108indicates whether an image has been captured for that particular eye atthe particular image focus point. The second image captured for a giveneye at an image point focus is indented from the first image capturedfor that eye and image point focus. Additionally, icon 1108 can includea graphical representation of the image quality score, such as byproviding a green dot, a yellow dot or a red dot. In some embodiments,when the image quality score is below a predetermined threshold, notonly is the dot red, but the checkmark in icon 1108 can be shadedlighter than for image quality scores higher than that pre-determinedthreshold. Icon 1112 indicates that no image has been captured for theparticular eye at the given image point focus.

Icon 1109 indicates the eye and optionally the image point focus of theimage. Specifically, the “R” indicates images for the right eye, and the“L” indicates images for the left eye.

The image point focus is indicated by the numeral following the R or L.Specifically, the numeral “1” indicates that a first image point focusaccording to a first prescriptive workflow was used to capture the notedimage(s), and the number “2” indicates that a second image point focusaccording to a second prescriptive workflow was used to capture thenoted image(s). For example, “R1” indicates that a right eye image wascaptured using a first prescriptive workflow dictating a first imagepoint focus. Additional details about the various prescriptive workflowsare provided with reference to FIGS. 53-58 described below.

Within the summary interface 1100, the user is provided a set ofenhanced user controls (e.g., icon 1122) by which to capture, in anintuitive manner, an optional, secondary image for each eye and imagingpoint of focus. The visual indicator and control, which indicates “addoptional”, allows the user to intuitively add one optional image foreach eye and imaging point, in addition to one previously captured imagefor that eye and imaging point. These controls are displayed in aparent-child subordinate relationship with the eye and imaging pointthat each is associated with, with the optional, secondary imageindented below the previously captured image.

For example, the icon 1122 enables the initiation of an additional imagecapture sequence without requesting any additional parameters for thegiven image capturing, at the particular eye and image point focus. Inother words, by selecting icon 1122 from the summary interface 1100, theuser can directly access the prescriptive workflow for capturing asecond image (e.g., acquisition interface 1050). This would allow forthe addition of an image for the left eye according to the firstprescriptive workflow.

Text 1123 provides a summary of this capability. Icon 1114 is showngrayed out because the functionality to add an additional image, at thegiven image point focus for the given eye, is not necessary because anoriginal image has not yet been captured for that particular eye at thatgiven image point focus. Upon capturing a first image, icon 1114 andtext 1115 will become operative controls in interface 1100.

Exam summary interface 1100 also includes controls 1140, 1142, and 1146.Save control 1140 enables clinician C to save the captured imageslocally and/or on a cloud based server. For instance, save control 1140can initiate saving of the captured images in the patient's electronicmedical record. Exam summary 1142 provides space for clinician C to makeany notes about a particular fundus exam. Control 1146 initiates thehome screen workflow, as shown in FIG. 45.

FIGS. 50-52 provide an example method for imaging a fundus of a patient1200. Example method 1200 parallels, essentially, workflow 1000described above. Typically, clinician C interacts with device 702 duringmethod 1200. Device 702 performs the steps for operations of examplemethod 1200. Other embodiments of method 1200 can include more or feweroperations.

Example method 1200 begins by receiving exam input (operation 1202).Receiving exam input (operation 1202) includes receiving selection of acontrol provided on an interface. The control initiates the start of afundus imaging workflow. As noted above, other controls in addition toexam initiation control can be provided on the initial workflowselection interface.

Next, a pre-acquisition interface is displayed (operation 1204). Thepre-acquisition interface includes various controls enabling clinician Cto select either the left or the right eye of the patient to image. Thepre-acquisition interface can also include controls enabling theclinician to identify a particular image point focus of a portion of thegiven eye. Additionally, the pre-acquisition interface can display asummary of which images have already been captured and at what imagepoint foci.

Next, device 702 receives eye input (e1) (operation 1206) and receivesfocus input (f1) (operation 1208). In some instances, eye input andfocus input (operations 1206 and 1208) are received simultaneously. Forexample, a given control on the pre-acquisition interface initiatesimage capture of the left eye macula-centered. Receiving the eye input(operation 1206) includes receiving a signal regarding which eye isgoing to be imaged and, in some instances, whether it is the first orthe second image captured for that eye. Receiving the focus input(operation 1208) indicates whether the image will be optic disc-focusedor macula-focused.

Upon receiving the eye input and focus input (operations 1206 and 1208),and optionally upon receiving selection of a start image capture control(not shown in method 1200), device 702 captures an image at the selectedeye input and focus point (e1, f1) (operation 1210). Optionally, examplemethod 1200 continues to display the captured image on a review screen(operation 1214). Example method 1200 can optionally proceed to one ormore of the operations shown in FIG. 51.

After capturing the first image at the image point focus for the giveneye (operation 1210), determination 1220 and operation 1226 can proceedin parallel or in series. Determination 1220 determines whether this isthe first image in the script for the particular eye. If it is not thefirst image for this eye at the given image point focus, then the addimage control is disabled in the review screen (operation 1222).Alternatively, if it is the first image in the script for the given eyeat the image point focus, then the add image control on the reviewscreen is enabled (operation 1224).

Additionally, after capturing the image (operation 1210), the imagequality of the first image is determined (operation 1226). Exampleprocesses and considerations for determining image quality are discussedin more detail above. After determining the first image quality(operation 1226), then the first image quality is displayed on thereview screen (operation 1228).

After the image is captured and various attributes are analyzed, theimage is displayed on a review screen (operation 1214). An examplereview screen is shown in FIG. 48 and described in more detail above. Ifclinician C does not want to capture any more images of a patient'sfundus, then a control can be selected to display exam summary 1100,described above.

In some instances, clinician C may want to acquire a second image of thegiven eye at the image point focus. The next operation in example method1200 is to receive a re-image control (operation 1216). Notably,re-image control 1076 is provided on the review interface 1070 withoutleaving the image capture workflow 1000 or the review interface.

Upon receiving selection of the reimage control, the method 1200proceeds to capture a second image at e1, f1 (operation 1218). Thesecond image captured during operation 1218 is captured at the sameimage point focus, with the same eye as the first image, and withoutrequiring any additional input from clinician C. Optionally, the imagequality of the second captured image is determined (operation 1212).

After capturing the second image at e1, f1 (, the second image isdisplayed on a review screen (operation 1214). Because this will be thesecond image for the given eye at the image point focus, the reimagecontrol will be disabled on the review screen.

Upon receiving selection of a proceed control, imaging summary data aredetermined (operation 1302). Referring to FIG. 52, determining imagingsummary data (operation 1302) includes compiling some or all of the datashown in exam summary interface 1100 in FIG. 49 above.

Next, determination 1304 evaluates whether the one image has beencaptured for the given eye. If only one image has been captured for thegiven eye, then an additional image control for the summary interface isenabled (operation 1306). If two images have been captured for the giveneye at the image point focus, then determination 1310 analyzes whetherthe patient's context is present. If patient context is present, thensave control on the summary interface is enabled (operation 1312). Afterboth determinations 1304 and 1310, the summary interface is provided onthe device (operation 1314).

In some instances clinician C may want to capture a second image of agiven eye at a given image point focus, particularly if the imagequality score is poor, at which point example method 1200 can includereceiving an additional image (operation 1316). As mentioned above withrespect to FIG. 49, additional image controls can be provided on examsummary interface 1100. Receiving the selection of additional imagecontrols (operation 1316) initiates image capture workflow (operation1308). Image capture workflow (operation 1308) has been described abovewith reference to FIGS. 44 through 51. Then the images can be stored(operation 1214) either locally or on a server, which can include anelectronic medical record server.

Some or all operations of example method 1200 can repeat for a differenteye and/or different image point focus. For example, after completingexample method 1200 to capture two images of a patient's left eye opticdisc-centered, the operations of example method 1200 repeat to captureone or two images of the patient's right eye optic disc-centered. In thedepicted examples, the workflow proceeds to capture images according tothe following order: R1, L1, R2, and L2. Although, in other examples,the user could skip certain images and/or modify the workflows to adifferent desired order.

Referring now to FIGS. 53-58, in some options, multiple prescriptiveworkflows are provided. Each prescriptive workflow can include adifferent focal point for the captured image(s). In this embodiment,camera aim indicator icons are provided to communicate to the user whereto place the camera, as well as communicating the number of expectedrequired images and/or unique imaging location for each prescribedimage. The enhanced camera aim indicator icons can provide, prior to theacquisition process begins, visual representations of left and righteyes, combined with a dot (e.g., colored) to visually indicate, in anintuitive manner, the unique imaging location to be captured for aprescribed image and eye in the digital retinal exam workflow.

In this example, FIGS. 53-54 illustrate pre-acquisition interface 1020(see FIG. 46) that allows for the capture of image of the left eye 1026and right eye 1027 according to a first prescriptive workflow. Thisfirst prescriptive workflow dictates the dot 1024 that device 702 willimage the left eye in macula-centered focus. This helps the userunderstand how the device 702 is focusing each image.

Similarly, for FIGS. 55-56, the dot 1024 is centered on the optic disc(i.e., optic disc-centered). This again helps the user understand howfocus will be performed. For FIGS. 57-58, the dot 1024 is focused on adifferent area of the eye to provide a different prescriptive workflow.Other configurations are contemplated.

The user can use one or more of the different focuses in accordance withone or more prescriptive workflows to use the device 702 to captureimages focused on different portions of the eye. As shown and describedabove, the images for the different prescriptive workflows can beaccomplished in a manner as shown in FIGS. 46-48, and the exam summaryinterface 1100 of FIG. 49 indicates all of the images captured for thedifferent prescriptive workflows.

In one example, the device 702 can be programmed (during setup of thedevice) to perform one, two, or more prescriptive workflows to captureimages at different focal points. The user can configure the device 702as desired. In another example, a remote device (e.g., server) canprogram the device 702 to perform one or more of the prescriptiveworkflows. For example, a caregiver can annotate a patient recordrequesting that both optic disc- and macula-centered images be taken fora patient. The server then programs the device 702 (e.g., throughcommunication through a network to the device) to perform the necessaryprescriptive workflows to accomplish the capture of the desired images.

The description and illustration of one or more embodiments provided inthis application are not intended to limit or restrict the scope of theinvention as claimed in any way. The embodiments, examples, and detailsprovided in this application are considered sufficient to conveypossession and enable others to make and use the best mode of claimedinvention. The claimed invention should not be construed as beinglimited to any embodiment, example, or detail provided in thisapplication. Regardless whether shown and described in combination orseparately, the various features (both structural and methodological)are intended to be selectively included or omitted to produce anembodiment with a particular set of features. Having been provided withthe description and illustration of the present application, one skilledin the art may envision variations, modifications, and alternateembodiments falling within the spirit of the broader aspects of theclaimed invention and the general inventive concept embodied in thisapplication that do not depart from the broader scope.

What is claimed is:
 1. A method for imaging a fundus of a patient,comprising: receiving an eye input, the eye input including anindication of a given eye of the patient to image; receiving a focusinput, the focus input indicating an image point focus of a portion ofthe given eye; capturing a first image of the given eye at the imagepoint focus; presenting a control on a graphical user interface, thecontrol configured to initiate an image acquisition sequence of thegiven eye; after receiving selection of the control, capturing a secondimage of the given eye at the image point focus; and storing both thefirst image and the second image.
 2. The method according to claim 1,further comprising: displaying the first image on a review screen of thegraphical user interface, the review screen additionally including thecontrol.
 3. The method according to claim 1, further comprising:analyzing the first image to determine a first image quality score; anddisplaying the first image quality score on the review screen.
 4. Themethod according to claim 1, wherein the image acquisition sequenceincludes displaying an acquisition interface, the acquisition interfaceenabling a user to manually or automatically initiate image capture; andwherein capturing a second image occurs without deleting the firstimage.
 5. The method according to claim 4, further comprising: setting aplurality of image capture parameters for capturing the first image,wherein the plurality of image capture parameters are also applied,without requesting user input, during capturing the second image.
 6. Themethod according to claim 1, further comprising: after capturing eitherthe first image or the second image, determining whether a precedingimage has already been captured in a script for the given eye; if nopreceding image has already been captured in the script for the giveneye, enabling the control on the graphical user interface; and if thepreceding image has already been captured in the script for the giveneye, disabling the control on the graphical user interface.
 7. Themethod according to claim 1, further comprising: displaying an examsummary interface providing a summary of image captures, the summary ofimage captures providing an indication of a number of images capturedfor each given eye and the image point focus for each of the imagescaptured.
 8. The method according to claim 7, further comprising:determining if patient context is present; and if patient context ispresent, enabling a save control in the exam summary interface, the savecontrol configured to initiate saving any captured images in a patientelectronic medical record.
 9. The method according to claim 1, furthercomprising: determining if patient context is present; and if patientcontext is present, enabling a save control in the exam summaryinterface, the save control configured to initiate saving any capturedimages in a patient electronic medical record.
 10. A method forcapturing one or more images of a fundus of a patient, the methodcomprising: on a display, providing a summary interface, the summaryinterface including: an indication of the number of images captured foreach eye; an indication of a focus type for each eye; and for eachcaptured image, an indication of the quality of the image; if only oneimage has been captured for a given eye at an image point focus, providea control to initiate an additional image capture; initiating a retinalimage capture workflow, the retinal image capture workflow resulting inimage capture of the selected eye with the selected focus type; anddisplaying to the summary interface after capturing the second image.11. The method according to claim 10, further comprising: analyzing afirst image to determine a first image quality score; and displaying thefirst image quality score on the summary interface.
 12. The methodaccording to claim 11, wherein the image acquisition sequence includesdisplaying an acquisition interface, the acquisition interface enablinga user to manually or automatically initiate image capture.
 13. Themethod according to claim 12, further comprising: setting a plurality ofimage capture parameters for capturing the first image, wherein theplurality of image capture parameters are also applied, withoutrequesting user input, during capturing a second image.
 14. The methodaccording to claim 13, further comprising: after capturing either thefirst image or the second image, determining whether a preceding imagehas already been captured in a script for the given eye; if no precedingimage has already been captured in the script for the given eye,enabling the control on the graphical user interface; and if thepreceding image has already been captured in the script for the giveneye, disabling the control on the graphical user interface.
 15. Themethod according to claim 14, further comprising: determining if patientcontext is present; and if patient context is present, enabling a savecontrol in the exam summary interface, the save control configured toinitiate saving any captured images in a patient electronic medicalrecord.
 16. The method according to claim 10, further comprising:determining if patient context is present; and if patient context ispresent, enabling a save control in the exam summary interface, the savecontrol configured to initiate saving any captured images in a patientelectronic medical record.
 17. A method for imaging a fundus of apatient, comprising: selecting a first prescriptive workflow forcapturing a first image of an eye, including: receiving a first eyeinput, the first eye input indicating a given eye of the patient toimage; receiving a first focus input, the first focus input indicating afirst image point focus of a first portion of the given eye; andcapturing a first image of the given eye at the first image point focus;selecting a second prescriptive workflow for capturing a second image ofthe eye, including: receiving a second eye input, the second eye inputindicating the given eye of the patient to image; receiving a secondfocus input, the second focus input indicating a second image pointfocus of a second portion of the given eye; and capturing a second imageof the given eye at the second image point focus; and storing both thefirst image and the second image.
 18. The method of claim 17, whereinthe first prescriptive workflow is a macula centered workflow.
 19. Themethod of claim 18, wherein the second prescriptive workflow is an opticdisc centered workflow.
 20. The method of claim 17, further comprisingpushing the first prescriptive workflow from a central server to adevice used to capture the first image.